As implementation of the Affordable Care Act begins in the US, it is time to examine medical institutions themselves.

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Bisan Salhi, MD, is a Clinical Educator in Emergency Medicine and a PhD student in the Department of Anthropology at Emory University.

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The ability to provide fair and equitable treatment is inherently linked to our ability to create supportive, fair institutions.

Is woman to nurse as man is to doctor? At face value, the answer is an obvious, resounding, "No!"

Indeed, the question itself may seem silly considering the historic advancements of women over the past century. It may also seem frivolous to pose this question in the wake of the Affordable Care Act (ACA), which promises to improve access to care for millions of Americans. And while the ACA is a critical step in improving Americans' health, it does not improve the gender gap within medicine itself. Many healthcare providers can attest to the subtle - and sometimes blatant - gender biases that remain pervasive in medicine. Despite tremendous achievements over the last several decades, women physicians still face barriers to professional advancement. Physicians and patients alike should be alarmed at this fact. How can we physicians truly provide quality, equitable care to our patients when we fail to recognise and combat our own institutional biases?

In the last several decades, medicine has been increasingly accessible to women, who now comprise nearly half of all medical students in the US. Women have also made significant headway in traditionally male-dominated specialties, such as general surgery, and are particularly prominent in specialties such as obstetrics/gynecology and pediatrics. This progress is encouraging, but misleading if not viewed in a broader context. Women make up only a third of physicians today. They remain underrepresented in a number of subspecialties, earn 37 percent less than their male colleagues, and get promoted lessoften in academic medicine than their male counterparts.

As in other fields, many people have weighed in to explain this discrepancy, suggesting that women do not value monetary compensation and therefore gravitate towards lower paying specialties than men. They have also suggested that women under-perform in medicine because they are not professionally driven, choosing to prioritise personal responsibilities at the expense of career advancement and economic gain. Yet it is impossible to believe that these women, who’ve sacrificed so much to practice medicine, can be accused of being unambitious. And even if we take these allegations seriously, the gender disparity persists when these factors are controlled for in studies. Women are simply not rewarded or recognised for similar work performed by men.

The ability to provide fair and equitable treatment is inherently linked to our ability to create supportive, fair institutions.

Gender bias and work environment

The problem, then, is not that women choose the "wrong" specialty or do not care enough about their careers. It is that gender bias and discrimination are pervasive in medicine. Despite laws forbidding such practices, women are often questioned in job interviews about their intentions to start families or become pregnant. They are viewed with suspicion when they interview for jobs, their colleagues often wondering silently - or even out loud - if their right to maternity leave will shift the burden of work to other physicians who have to cover the workload. I have heard this from many female physicians over the years, and I doubt that male physicians are similarly questioned about their intentions to have families and what this will mean for the work environment.

Studies have also shown that women do not enjoy the same level of professional status as male physicians. Women are often targets of gender stereotyping and discrimination. As a female physician, I, like so many others, have experienced this personally. As one of my female colleagues very matter-of-factly asked me, "How many times have you been mistaken for a nurse?" I nodded in agreement, thinking of the multiple occasions when I have walked into patients’ rooms as they were speaking on the phones and heard them say, "I’ll have to call you back, my nurse is here." And while the assumption is neither meant nor construed as an insult - I am proud to work alongside some of the best and hardest working male and female nurses - it is indicative of an inherent gender bias. Most patients are embarrassed by their presumptions when they are pointed out, but I wonder if they are aware of it the next time they are taken care of by a female physician.

Other manifestations of sexism are more subtle. I have walked into rooms and noticed that male doctors garner more attention than I do from patients. Is that because they are male, taller, or because they are viewed with curiosity? I am not sure. Still, the evidence points towards a pervasive double standard. For example, when patients were surveyed on attitudes about physicians’ dress, they tended to place greater importance on the clothing of women physicians than men's. The implication is clear: Women have to "dress the part" in order to prove themselves. Competence is not a given.

It is important to realise that these inequities in medicine belong to everyone - male and female, physician and patient. Illness is an inevitable fact of life. It renders each of us scared and vulnerable, in need of compassionate, humane care. It is the physicians’ duty to provide that care to each of the patients. You deserve nothing less. But the ability to provide fair and equitable treatment is inherently linked to our ability to create supportive, fair institutions.

Sexism in medicine is not isolated - just ask female investment bankers or athletes - but it is of consequence. Physicians strive to treat all patients with dignity. We study for years and work nights, weekends, and holidays to accomplish this goal. Our institutional and professional structures must reflect this. Our health and wellbeing depend on it.

Bisan Salhi, MD, is a Clinical Educator in Emergency Medicine and a PhD student in the Department of Anthropology at Emory University. She is currently an Op Ed Project Public Voices Fellow.

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